Application values of transport risk index of physiologic stability in assessment of illness severity of premature infants

doi:10.3877/cma.j.issn.1673-5250.2018.05.005

Objective

To investigate the values of transport risk index of physiologic stability (TRIPS) at admission to evaluate illness severity and prognosis of preterm infants.

Methods

From July 2014 to December 2016, a total of 130 preterm infants with gestational age < 32 weeks who were hospitalized in the neonatal intensive care unit (NICU) of Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University were selected as research subjects. All preterm infants included in the study were given TRIPS score and neonatal critical illness score (NCIS) at the same time. Pearson correlation analysis was used to analyze the correlation between TRIPS score and NCIS, then the results of NCIS were taken as standard, the receiver operating characteristic (ROC) curve which assessed the severity of preterm infants with TRIPS score was drawn, to get the best cutoff value of TRIPS score in judging the severity of preterm infants. According to this best cutoff value, preterm infants of this study were divided into two groups: the non-critical group (TRIPS score < the best cutoff value) and the critical group (TRIPS score > the best cutoff value). The independent-samples t test, Wilcoxon rank sum test and chi-square test were used to compare the measurement and numeration data of premature birth related complications and clinical outcomes between two groups of preterm infants. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

①Pearson correlation analytic results showed that there was a linear negative correlation between TRIPS score and NCIS (r=-0.421, P<0.001). ②The ROC curve of evaluation of the severity of preterm infants by TRIPS score showed that the best cutoff value for judging the severity of preterm infants by TRIPS score was 13.5 scores, the area under curve (AUC) was 0.721(95%CI: 0.634-0.807), the sensitivity was 86.5%, and the specificity was 52.6%. ③Grouping results according to the best cutoff value of TRIPS score were 76 preterm infants in non-critical group and 54 cases in critical group. ④The incidence rate of bronchopulmonary dysplasia (BPD) and intracranial hemorrhage of preterm infants in critical group (37.0%, 40.7%) were all higher than those in non-critical group (15.8%, 15.8%), also the body weight at discharge from NICU and hospital discharge rate based on improved patients′ condition in critical group [(2 025±533) g, 72.2%] were all lower than those in non-critical group [(2 192±267) g, 96.1%], and all the differences were statistically significant (χ²=7.681, P=0.006; χ²=10.176, P=0.001; t=-2.351, P=0.020; χ²=15.441, P<0.001). There were no significant differences between two groups of preterm infants in incidence rate of necrotizing enterocolitis, hospital onset of infection, retinopathy of prematurity (ROP) and duration of hospitalization (P>0.05).

Conclusion

TRIPS score at admission could be used to evaluate illness severity and prognosis of preterm infants.

Key words: Intensive care units, neonatal, Transport risk index of physiologic stability, Neonatal critical illness score, ROC curve, Bronchopulmonary dysplasia, Intracranial hemorrhages, Infant, premature

图1 130例早产儿转运生理稳定指数评分与新生儿危重病例评分的散点图

图2 转运生理稳定指数评分评估早产儿病情危重度的受试者工作特征曲线

表2 2组早产儿相关并发症及临床转归比较

组别	例数	TRIPS评分[分，M(P₂₅～P₇₅)]	BPD [例数(%)]	坏死性小肠结肠炎[例数(%)]	院内感染[例数(%)]	ROP [例数(%)]	颅内出血[例数(%)]
非危重组	76	6.0(6.0～12.0)	12(15.8)	2(2.6)	12(15.8)	1(1.3)	12(15.8)
危重组	54	21.5(21.0～28.0)	20(37.0)	1(1.9)	14(25.9)	5(9.3)	22(40.7)
检验值	?	Z＝－9.284	χ²＝7.681	χ²＝0.091 ^a	χ²＝2.027	χ²＝2.900 ^a	χ²＝10.176
P值	?	<0.001	0.006	0.763	0.154	0.089	0.001
组别	例数	住院时间[d，M (P₂₅～P₇₅)]	转出NICU时体重(g，±s)	结局[例数(%)]
组别	例数	住院时间[d，M (P₂₅～P₇₅)]	转出NICU时体重(g，±s)	好转出院	死亡	转上级或专科医院
非危重组	76	39.0(28.0～49.0)	2 192±267	73(96.1)	0(0)	3(3.9)
危重组	54	47.0(28.5～59.0)	2 025±533	39(72.2)	3(5.6)	12(22.2)
检验值	?	Z＝－1.914	t＝－2.351	?	χ²＝15.441	?
P值	?	0.056	0.020	?	<0.001	?

表2 2组早产儿相关并发症及临床转归比较

组别	例数	TRIPS评分[分，M(P₂₅～P₇₅)]	BPD [例数(%)]	坏死性小肠结肠炎[例数(%)]	院内感染[例数(%)]	ROP [例数(%)]	颅内出血[例数(%)]
非危重组	76	6.0(6.0～12.0)	12(15.8)	2(2.6)	12(15.8)	1(1.3)	12(15.8)
危重组	54	21.5(21.0～28.0)	20(37.0)	1(1.9)	14(25.9)	5(9.3)	22(40.7)
检验值	?	Z＝－9.284	χ²＝7.681	χ²＝0.091 ^a	χ²＝2.027	χ²＝2.900 ^a	χ²＝10.176
P值	?	<0.001	0.006	0.763	0.154	0.089	0.001
组别	例数	住院时间[d，M (P₂₅～P₇₅)]	转出NICU时体重(g，±s)	结局[例数(%)]
组别	例数	住院时间[d，M (P₂₅～P₇₅)]	转出NICU时体重(g，±s)	好转出院	死亡	转上级或专科医院
非危重组	76	39.0(28.0～49.0)	2 192±267	73(96.1)	0(0)	3(3.9)
危重组	54	47.0(28.5～59.0)	2 025±533	39(72.2)	3(5.6)	12(22.2)
检验值	?	Z＝－1.914	t＝－2.351	?	χ²＝15.441	?
P值	?	0.056	0.020	?	<0.001	?

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